Archives

Accountable Care Meets Analytics at AHIP

We are in San Francisco this week at the America’s Health Insurance Plans (AHIP) Conference. This is a great event, and there are a lot of themes being evaluated by the conference attendees. One hot topic from our blog is how to create sustainable Accountable Care models. This Thursday late morning session was standing room only and shows the strong level of interest in ACOs.

The session by Deloitte Consulting had an interesting twist – live audience surveys using text messages to create real-time bar charts of the results. For example, when the audience was asked what was driving the interest in Accountable Care, 56% said Rate and Margin pressure, while 40% said it was Outcome based payment terms, and finally only 4% said that dropping Traditional Barriers was the driver. The survey indicated that dropping traditional barriers like the creation of health information exchanges or increased pressure for transparency aren’t top of mind versus addressing increasing rate and margin pressures.

Another key observation by the speakers was that collaboration will be mandatory in order to manage episodic care between the plan, provider and member. In order to move from the traditional fee for service model to quality-based episodic payments then a moderate level of collaboration is required between the three parties and that introduces a moderate degree of risk as well. Communication needs to be bidirectional and outcome focused to manage costs while maintaining quality.

When the audience was surveyed on the best approach for accountable care from three possible choices, the results were equally surprising. The Medical Home approach garnered 56% of the votes, while the Integrated System approach was 32% and Condition Specfic ACOs (diabetes, obesity, heart disease) scored 27%. What was surprising was that a vote for the Medical Home approach said that AHIP attendees liked an open market approach with an educated consumer versus the Integrated System which would be more like a public utility, vertically integrated and possibly monopolistic. The Medical Home approach popularity may come from retaining an aligned competitive environment that would help drive down costs.

The final observation about building a sustainable model for accountable care is that the approach must be based on a strong information management foundation including enterprise data warehousing, advanced analytics and data governance. In order to track outcomes for judging quality and episodic care management, then near real-time, holistic and integrated information will be critical to success. The speaker admonished the crowd: “You have to compete on analytics!” He went on to observe that there isn’t a single source solution today, however a roadmap must be developed for technology to support the new world of accountable care.

The time to have a dialog on this technology roadmap for ACOs is now – what do you think?